Report Reveals Surprises Leading to First IVF Baby

The U.K. Medical Research Council's decision not to support Robert Edwards' and Patrick Steptoe's research on in vitro fertilization in the early 1970s was considerably more thoughtful than the story most people know, according to a review of government and other archives.

Denied MRC funding in 1971, Edwards and Steptoe found private sources of support for their program, which led seven years later to the birth of the world's first "test tube baby," Louise Brown.

Brown will celebrate her 32nd birthday tomorrow, and that event is commemorated in the journal Human Reproduction by the online publication of the detailed history of the efforts leading up to her birth.

It was widely believed that the MRC, which is the U.K. equivalent of the National Institutes of Health, refused to support the project because it feared attacks from religious conservatives and because the two researchers were relative outsiders in the British medical world.

But Martin H. Johnson, PhD, a science historian at the University of Cambridge in England, and colleagues who reviewed official records found that, while those considerations did play a role in the final decision, they were by no means the only ones or even the most important.

Following the births of Brown and a second baby in 1978, the MRC decision was almost universally derided in the press as narrow-minded and shortsighted. Edwards and Steptoe were lionized as visionary heroes.

But the MRC's decision to withhold funding, Johnson and colleagues found, was based on more than fear and prejudice. "[It] was the outcome of complex negotiations, extensive deliberation, and due process," and is understandable and even reasonable given what was known in 1971, they concluded.

In an accompanying editorial, John D. Biggers, DSc, PhD, of Harvard Medical School, called the new history "perceptive," adding that it "demonstrated the importance of understanding a decision in light of the culture and circumstances at the time the decision was made."

Johnson and colleagues identified factors that entered into committee reviews, negotiations with Edwards and Steptoe, and the final MRC decision that were not previously made public or were simply left out of the standard accounts.

These included the large sum of money that the researchers had requested -- equivalent to well over $1 million per year in 2010 dollars -- and their insistence on setting up their proposed clinic at the University of Cambridge, where Edwards was on the faculty but lacked a medical degree (he had a PhD in genetics).

The researchers rejected a proposal from MRC reviewers that they instead join a new clinic at a hospital in Harrow that the agency was funding, which would have given them allies in the system and made it easier administratively for the MRC to approve their project.

Another factor was that some reviewers questioned the wisdom of funding a program to help women give birth, at a time when overpopulation -- both globally and in Britain -- was a major public health concern.

The low success rate in achieving fertilization and viable oocyte development also raised eyebrows, as did results from animal experiments in which some of the successful births showed developmental abnormalities.

Additionally, it appears that some grant reviewers disliked Edwards' frequent appearances in the media to promote the idea of in vitro fertilization.

"He considered this necessary to prepare society to 'keep pace' with 'the transition of scientific discovery into technological achievement,'" Johnson and colleagues wrote, but records of the reviewers' deliberations showed that some believed serious scientists shouldn't court public attention.

According to one, quoted by Johnson and colleagues, "I do not feel that an ill-informed general public is capable of evaluating the work and seeing it in its proper perspective. This publicity has antagonised a large number of Dr. Edwards' scientific colleagues, of whom I am one."

The initial refusal of funding is easier to defend than the MRC's subsequent policy reversal after Edwards and Steptoe engineered the successful births of Brown and another infant, at which point it threw its full support behind IVF research, Johnson and colleagues contended.

"It is the 1978 decision that was made on surprisingly thin evidence," they argued.

That evidence, they suggested, consisted solely of the "two healthy births, one 11-week ectopic pregnancy, two chemical pregnancies (positive for pregnancy hormones, but no evidence of a sustained implant), one premature loss of a normal fetus at 21 weeks, and one miscarried triploid fetus."

On that basis, Johnson and colleagues wrote, "the MRC reconstructed IVF as an experimental treatment and no longer as purely a research procedure."

The new policy even allowed the creation of human-animal hybrid embryos, they pointed out. Curiously, though, generous MRC funding became available for development of new and improved IVF procedures, but none was provided for follow-up of the resulting procedures.

Johnson and colleagues said the saga of Edwards' and Steptoe's efforts to secure official backing had a parallel in the 1930s, when another scientist who conducted promising research on in vitro fertilization and embryo transfer, Gregory Pincus, was denied tenure at Harvard.

Pincus' story, like that of Edwards and Steptoe, became one that "pitt[ed] courageous mavericks against conservative establishments," Johnson and colleagues wrote, even though the truth in both cases was considerably more complex.

Such stories, they noted, "contain important elements of truth: Edwards and Steptoe were outsiders and did pioneer -- against prevailing wisdom -- new ideas, therapies, values, public discourses, and ethical thinking. But the standard histories also risk promoting an unduly simple view of how such decisions work. Richer accounts may be better guides to action, in the present as well as the past."

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